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Pakistan’s Polio Program at Zero Dark Thirty

Dr. Qanta Ahmed is a an Associate Professor of Medicine at the State University of New York and author of In the Land of Invisible Women (Sourcebooks 2008) an account of her time in Saudi Arabia. She has published widely globally including in The Netherlands' Trouw, The Jerusalem Post,The Gulf Times, The Guardian, The Daily Telegraph, The Wall Street Journal, The Christian Science Monitor, The New York Post, The New York Daily News, Pakistan’s The Daily Times, The Daily Beast, Israel's Haaretz and the Times of Israel and elsewhere.

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Polio is a devastating infectious disease, paralyzing many of those infected. In the Islamic Republic of Pakistan where the Taliban recently executed sixteen health workers engaged in the nation’s polio eradication program, preventing the disease has become much more difficult.

Following the Taliban’s targeted assassinations of polio workers, Pakistan’s polio program is in acute collapse. Though the program has tentatively reopened under security detail, workers continue to die in the line of duty. In copycat fashion, last month workers were shot dead while vaccinating in Nigeria’s Kano province, likely executed by Nigeria’s Islamist group, Boko Haram. Just last week AlJazeera reports that another policeman has been killed guarding a Pakistani vaccination team.

I have recently traveled to the SWAT valley to inspect a high-risk health program under Pakistani military protection in KPK’s Mingora and Malakand. Even as an experienced traveler to Pakistan, fluent in Urdu and fully veiled as a conservative Muslim woman, I found the situation frighteningly volatile. Neither being an observant Muslim, nor being a volunteer doctor offers protection in Pakistan.

Yet while ruthlessly brutal, the Taliban is highly intelligent. The Taliban specifically target the rights of girls to an education and of women to autonomy, citing both to be ‘western’ ‘unIslamic’ secularization. Since both education and public health are deeply entwined, the Taliban has amplified obstacles to eradicating polio in one of the most difficult regions in the world. In Pakistan, as in many Muslim communities, it is only acceptable for women to enter homes as visitors, particularly in order to counsel a mother. Pakistan’s polio program thus relies upon educated (and often young) women going door-to-door to engage with mothers.

Matters are worsened in the wake of Pakistan’s recently decentralized public health system. Following Pakistan’s parliamentary decision to abolish their Federal Ministry of Health in June 2012, officials now operate from independent provincial departments. The killings began a month later and have sent the newly fragmented health authorities scrambling for a unified response.

Pakistan is one of three remaining countries in the world where polio persists, threatening to trigger global reemergence. Both Afghanistan and Pakistan have seen a rise in polio after 2002 because of the ongoing Af-Pak conflict. Beliefs pose barriers greater even than armed conflict.

Pakistani parents, like American parents, know ‘what’s best’ for their own child. By far the most common reason the polio vaccine is not delivered is the refusal of Pakistani parents on the grounds of lack of confidence and strongly held beliefs – perpetuated by the Taliban that the vaccine is ‘unIslamic.’ The Pakistani Taliban continues to peddle commonly held misperceptions that the vaccination is also a covert American sterilization program, conspiracies which an uneducated populace is quick to embrace. Even so there is no escaping that America has directly fueled the fire. Both the CIA and Hollywood have compounded to Pakistan’s polio problem by feeding into the Taliban’s deviant messaging.

The truly deplorable association of vaccination programs with the CIA’s mission to capture Osama Bin Laden in Abbottabad has damaged Pakistanis’ public confidence in vaccinations in general and public health workers in particular while fueling conspiracy theories. ‘Zero Dark Thirty’, claimed by director Kathryn Bigelow to be based on ‘reporting’ misportrays CIA collaborator Dr. Shakeel Afridi’s actions as a sham polio eradication program (rather than the real-life sham-Hepatitis B vaccination campaign which was his actual cover). Because of this, Zero Dark Thirty unwittingly adds resistance to Pakistan’s polio program which now seems even more so (to the uninformed) to be an ongoing CIA operation in some of Pakistan’s most conflicted zones. Though the movie is not officially released in Pakistan, nor slated for it, pirated copies are already circulating and together with media commentary about the CIA mission, cynicism has deepened, further endangering polio workers.

Building trust in the mission and the polio vaccine depends now as much on Muslim Diaspora as much as it does on American aid dollars from the Gates Foundation, The Rotary Club and others. It is critical that Muslims, and Muslim physicians in particular, address Taliban intimidation through corrective hybridized public health and religious messaging. If ever there was a time to seek a fatwa, this is it guys. Pakistan’s vociferous ‘Mullah-ocracy’ could be put to great effect by issuing edicts supporting the national effort to contain disease and protect Pakistan’s children from polio as Islamic and denouncing the Taliban’s campaign of execution as profoundly unIslamic.

Meanwhile as Americans we must ask ourselves how our country’s best exports- fantastical military weaponry and Hollywood blockbusters- converge reality into new fantasies to drive the supercharged anti-Americanism now actively endangering innocent lives in one of the most vulnerable regions in the world.

Sadly, the mercurial Muslim world is quick to enrage with matters deemed ‘blasphemous’ as last week’s tragic events in Lahore show, though they are yet to turn their attention to Pakistan’s Polio program and the Taliban’s atrocities exacted against it. These actions by the Taliban not only extinguish Pakistan’s dedicated, poorly paid and largely female health professionals, but jeopardize hundreds of thousands of Muslim children every day.

Until the Muslim world trains its focus on this challenge to support Pakistan, the Taliban will retain the upper hand and Pakistan’s polio campaign will remain suspended at Zero Dark Thirty.